1
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Gershman E, Azem K, Heesen P, Pertzov B, Rosengarten D, Bruckheimer E, Peysakhovich Y, Kramer MR. Amplatzer Occluders for Effective Nonsurgical Management of Bronchopleural Fistulae. Ann Thorac Surg 2023:S0003-4975(23)00932-3. [PMID: 37696352 DOI: 10.1016/j.athoracsur.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/08/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND To assess the safety and efficacy of bronchopleural fistulae closure with Amplatzer occluder devices (AGA Medical, Golden Valley, MN) through our experience of over 14 years. METHODS Retrospective data review of patients from Rabin Medical Center who underwent Amplatzer occluder device placement between March 2007 and September 2021 for bronchopleural fistulae closure. RESULTS In total, 72 patients had 83 Amplatzer occluder devices implanted for bronchopleural fistulae closure. The median age was 65.5 (interquartile range 56.0-72.3) years. The primary diseases were lung malignancy (48 [66.7%]) and thoracic infection (9 [12.5%]). Bronchopleural fistulae developed mainly following pneumonectomy (40.3%) and lobectomy (33.3%), with a median time from surgery to Amplatzer placement of 3.9 (interquartile range 1.4-16.4) months. We encountered no procedural or immediate postprocedural complications or deaths. Six months after Amplatzer insertion, there were 7 (8.4%) Amplatzer removals and 11 (15.3%) fistula-related deaths. CONCLUSIONS Amplatzer occluders are a safe modality for nonsurgical bronchopleural fistulae management with ease of placement under moderate sedation and flexible bronchoscopy with good short- and long-term effectivity.
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Affiliation(s)
- Evgeni Gershman
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel; Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Karam Azem
- Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel; Department of Anesthesiology, Rabin Medical Center, Petah Tikva, Israel
| | - Philip Heesen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland
| | - Barak Pertzov
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel; Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel; Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Bruckheimer
- Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel; Department of Pediatric Cardiology, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Yuri Peysakhovich
- Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel; Department of Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Mordechai R Kramer
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel; Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel.
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2
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Bashour SI, Ost DE. An update on bronchopleural fistulae following cancer-related surgery. Curr Opin Pulm Med 2023; 29:223-231. [PMID: 37102602 DOI: 10.1097/mcp.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
PURPOSE OF REVIEW Bronchopleural fistulae (BPF) are rare complications in cancer-related surgery but impart significant morbidity and mortality. BPF may be difficult to identify, with a broad differential diagnosis at presentation, so it is critical to be aware of newer diagnostic and therapeutic approaches for this disease entity. RECENT FINDINGS Multiple novel diagnostic and therapeutic interventions are featured in this review. Reports of newer bronchoscopic techniques to localize BPF, as well as approaches for bronchoscopic management, like stent deployment, endobronchial valve placement, or alternative interventions when indicated are discussed, paying particular attention to factors that influence procedure selection. SUMMARY Management of BPF remains highly variable, but several novel approaches have shown improved identification and outcomes. Although a multidisciplinary approach is imperative, an understanding of these newer techniques is important to provide optimal care for patients.
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Affiliation(s)
- Sami I Bashour
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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3
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Ellebrecht DB, Kugler C. Intraoperative Determination of Bronchus Stump and Anastomosis Perfusion with Hyperspectral Imaging. Surg Innov 2023:15533506231157165. [PMID: 36802983 DOI: 10.1177/15533506231157165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND The intraoperative evaluation of bronchus perfusion is limited. Hyperspectral Imaging (HSI) is a newly established intraoperative imaging technique that enables a non-invasive, real-time perfusion analysis. Therefore, the purpose of this study was to determine the intraoperative perfusion of bronchus stump and anastomosis during pulmonary resections with HSI. METHODS In this prospective, IDEAL Stage 2a study (Clinicaltrials.gov: NCT04784884) HSI measurements were carried out before bronchial dissection and after bronchial stump formation or bronchial anastomosis, respectively. Tissue oxygenation (StO2; upper tissue perfusion), organ hemoglobin index (OHI), near-infrared index (NIR; deeper tissue perfusion) and tissue water index (TWI) were calculated. RESULTS Bronchus stumps showed a reduced NIR (77.82 ± 10.27 vs 68.01 ± 8.95; P = 0,02158) and OHI (48.60 ± 1.39 vs 38.15 ± 9.74; P = <.0001), although the perfusion of the upper tissue layers was equivalent before and after resection (67.42% ± 12.53 vs 65.91% ± 10.40). In the sleeve resection group, we found both a significant decrease in StO 2 and NIR between central bronchus and anastomosis region (StO2: 65.09% ± 12.57 vs 49.45 ± 9.94; P = .044; NIR: 83.73 ± 10.92 vs 58.62 ± 3.01; P = .0063). Additionally, NIR was decreased in the re-anastomosed bronchus compared to central bronchus region (83.73 ± 10.92 vs 55.15 ± 17.56; P = .0029). CONCLUSIONS Although both bronchus stumps and anastomosis show an intraoperative reduction of tissue perfusion, there is no difference of tissue hemoglobin level in bronchus anastomosis.
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Affiliation(s)
- David B Ellebrecht
- Department of Surgery, 9213LungClinic Großhansdorf, Großhansdorf, Germany
| | - Christian Kugler
- Department of Surgery, 9213LungClinic Großhansdorf, Großhansdorf, Germany
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4
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Porkhanov VA, Zhikharev VA, Bushuev AS, Zima VS, Koryachkin VA, Ivanova MP. [Early predictor of bronchial suture failure after pneumonectomy]. Khirurgiia (Mosk) 2023:71-77. [PMID: 37916560 DOI: 10.17116/hirurgia202310171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To identify the relationship between serum CRP/albumin and bronchial suture failure after pneumonectomy. MATERIAL AND METHODS A retrospective analysis included 100 patients who underwent pneumonectomy with extended lymph node dissection for lung cancer. Patients were divided into 2 groups depending on postoperative complications: group 1 - bronchial stump failure, group 2 - no similar complications. In all patients, we analyzed markers of inflammation (C-reactive protein and albumin) in preoperative period and after 24 postoperative hours. Bronchial stump failure was found in 20 patients (10 patients (14.7%) after left-sided pneumonectomy and 10 (31%) patients after right-sided pneumonectomy). We found a significant relationship between serum CRP/albumin and bronchial stump failure after pneumonectomy (p<0.05). A prognostic formula was based on the ratio of serum C-reactive protein and albumin: PC = CRP/Alb, where PC - prognostic coefficient, CRP - serum C-reactive protein (mg/l) 24 hours after surgery, Alb - serum albumin (g/l) 24 hours after surgery. PC >2.6 determines high risk of bronchial stump failure after pneumonectomy, PC <2.6 - low risk. Sensitivity of this method is 90%, specificity - 97.5%.
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Affiliation(s)
- V A Porkhanov
- Research Institution - Ochapovsky Regional Clinic Hospital No. 1, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - V A Zhikharev
- Research Institution - Ochapovsky Regional Clinic Hospital No. 1, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - A S Bushuev
- Research Institution - Ochapovsky Regional Clinic Hospital No. 1, Krasnodar, Russia
| | - V S Zima
- Research Institution - Ochapovsky Regional Clinic Hospital No. 1, Krasnodar, Russia
| | - V A Koryachkin
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - M P Ivanova
- Astana Medical University, Astana, Republic of Kazakhstan
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Geyik FD, Dogruyol T, Kahraman S, Arslan G, Saracoglu KT, Demirhan R. Short-Term Outcomes of Fiberoptic Bronchoscopy-guided Resection and Anastomosis Control in Thoracic Surgery. Surg Laparosc Endosc Percutan Tech 2022; 32:673-676. [PMID: 36223315 DOI: 10.1097/sle.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In thoracic surgery practice, bronchial closure and anastomosis are relatively easy in technical terms; however, it is also the procedure that is most open to the development of complications with high morbidity. This study aimed to investigate the effect of simultaneous evaluation of bronchial closure under fiberoptic bronchoscopy guidance during lung resection on the development of complications. MATERIALS AND METHODS Patients aged over 18 years who underwent elective lung resection in our clinic between 2017 and 2021 were included in the study. Postoperative complications were recorded and statistically analyzed. RESULTS The mean age of the patients was 61.4±10.4 years, and 267 patients were male (75.4%) and 87 (24.6%) were female. Thoracotomy was performed in 258 (72.9%) patients and lung resection with the video-assisted thoracoscopic surgery technique in 96 (27.1%) patients. During the follow-up, complications were observed during the first 30 days in 78 (22.0%) of the patients and later in 9 (2.5%). Surgical mortality occurred in 11 patients (3.1%), and the rate of readmission to the intensive care unit was 5.6% (n=20). CONCLUSION We consider that the control of the resection line with the active use of fiberoptic bronchoscopy during surgery is important for the prevention of the development of bronchial morbidity. Complications in the early period can be reduced by ensuring that the remaining bronchus is not narrowed, there are no residual stump structures that may disrupt the bronchial line, such as cartilage, and bronchial washing is frequently undertaken.
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Affiliation(s)
- Fatih Dogu Geyik
- Department of Anesthesiology and Reanimation, Kartal Dr Lutfi Kirdar City Hospital
| | | | | | - Gulten Arslan
- Department of Anesthesiology and Reanimation, Kartal Dr Lutfi Kirdar City Hospital
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6
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Ceylan KC, Batıhan G, Kaya ŞÖ. Novel method for bronchial stump coverage for prevents postpneumonectomy bronchopleural fistula: pedicled thymopericardial fat flap. J Cardiothorac Surg 2022; 17:286. [DOI: 10.1186/s13019-022-02032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Bronchopleural fistula (BPF) is a serious complication with high mortality and morbidity that can be seen after lung resections. Although several methods have been described to prevent postoperative BPF it is still unclear which method is the best. In this study, we have used tymopericardial fat flap (TPFF) to cover the bronchial stump in patients after pneumonectomy and aim to show its feasibility and efficacy to prevent BPF.
Methods
Between January 2013 and June 2021, 187 patients with lung cancer underwent pneumonectomy at our institution. Among them, 53 patients underwent bronchial stump coverage with TPFF. In other 134 patients there wasn’t used any coverage method. Patient characteristics, preoperative status, surgical procedures, perioperative course, pathological findings, and long-term prognoses were evaluated retrospectively.
Results
Postoperative BPF was observed in 16 (%8.5) patients. It was observed that TPFF was applied in only 1 of the patients who developed BPF. A statistically significant difference was detected between TPFF-coverage with non-coverage groups in terms of postoperative BPF rates (p = 0.044). Other factors associated with the development of postoperative BPF in univariate analysis were right sided pneumonectomy, and re-operation.
Conclusion
Bronchial stump coverage with TPFF is a feasible and effective method to prevent postpneumonectomy BPF.
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7
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Wang L, He Z, Zhang C. Preliminary experience of autologous free myocutaneous flap combined with free dermal graft in the treatment of refractory empyema with bronchopleural fistula. Heliyon 2022; 8:e11251. [PMID: 36339755 PMCID: PMC9634368 DOI: 10.1016/j.heliyon.2022.e11251] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/16/2022] [Accepted: 10/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To explore the effects of autologous free dermal graft combined with free myocutaneous flap on bronchopleural fistula (BPF) with empyema, we summarized and analyzed two cases. Methods Two patients with refractory empyema and BPF were treated with autologous free dermal graft combined with free myocutaneous flap. The treatment included debridement of empyema, rib resection drainage, repair of bronchopleural fistula, and free vastus lateralis myocutaneous flap transplantation to eliminate the empyema. After the free dermal graft was harvested from the healthy skin around the incision, it was inserted into the fistula and sutured with the surrounding pleural tissue. The keys to the operation lies in the anastomosis of the lateral circumflex femoral artery (LCFA), vein and nerve that supply the vastus lateralis muscle flap to the thoracodorsal vessels and nerves. After surgery, the empyema, air leakage, and the survival of the myocutaneous flap were observed. Results There was no disease recurrence after follow-up for seven and six months, respectively. Re-examination of the chest computed tomography (CT) or magnetic resonance imaging (MRI) indicated that the abscess cavity had disappeared. No necrosis of the myocutaneous flap was observed after surgery. Conclusion The application of autologous free dermal graft combined with free vastus lateralis myocutaneous flap transplantation is effective in the treatment of patients with bronchopleural fistula with refractory chronic empyema, and the clinical effect is satisfactory. Surgical treatment of refractory empyema. Autologous free dermal graft combined with free myocutaneous flap in the treatment of refractory bronchopleural fistula with empyema. Application of free myocutaneous flap in patients with empyema.
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Affiliation(s)
- Lei Wang
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China
| | - Zhongliang He
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China
- Corresponding author.
| | - Chun Zhang
- Department of Traumatology and Orthopedic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China
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Lo Iacono G, Prisciandaro E, Mohamed S, Bertolaccini L, Girelli L, Sedda G, Mazzella A, Guarize J, Donghi S, Spaggiari L. Cover always the bronchial stump! A flap could prevent catastrophic complications even in complete broncho-pleural fistula. Indian J Thorac Cardiovasc Surg 2022; 38:549-552. [PMID: 36050968 PMCID: PMC9424437 DOI: 10.1007/s12055-022-01386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022] Open
Abstract
Broncho-pleural fistula after pneumonectomy is a life-threatening condition with very high mortality rate, even if detected early. All symptomatic patients should be treated immediately. The diagnosis in the absence of symptoms poses the real difficulties of management. Early detection of asymptomatic post-pneumonectomy broncho-pleural fistula is usually fortuitous. The use of bronchoscopy allows direct and accurate evaluation of the stump. This reported case allows us to make several considerations on the treatment of fistulas, but above all to consider that the systematic bronchial stump coverage is fundamental not only for preventing fistulas, but also for limiting their enlargement and communication with the residual cavity, in order to prevent catastrophic complications.
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Affiliation(s)
- Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy
| | - Elena Prisciandaro
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy
| | - Lara Girelli
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy
| | - Antonio Mazzella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy
| | - Juliana Guarize
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy
| | - Stefano Donghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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9
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Mazzella A, Bertolaccini L, Sedda G, Prisciandaro E, Loi M, Iacono GL, Spaggiari L. Pneumonectomy and broncho-pleural fistula: predicting factors and stratification of the risk. Updates Surg 2022; 74:1471-1478. [PMID: 35416586 DOI: 10.1007/s13304-022-01290-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
The goal of the study is to evaluate the different risk factors and stratify the patients, before the surgery, into distinct risk classes. We retrospectively reviewed pre, peri, and postoperative outcomes of 366 consecutive patients who underwent pneumonectomy for lung cancer between the last 10 years (2009-2019). We classified the patients into four classes, depending on preoperative assessments. Differences between groups were assessed with the log-rank test. Multivariable Cox proportional hazards regression analysis was used to assess the independent prognostic significance of the variables associated with the development of BPF at univariate analysis. Finally, we performed non-linear [artificial neural network (ANN)] multiple regression analyses. All tests were two-sided, and p values < 0.05 were considered significant. Fifty-one patients (13.9%) out of 366 developed BPF. Male sex (p = 0.048), right side (p = 0.015), postoperative pulmonary complications (p = 0.0139) and adjuvant treatments (p = 0.0169) were the independent predicting factors of fistulas in multivariate analysis. The right side (p = 0.043) and adjuvant treatments (p = 0.032) were the independent predicting factors of BPF after the ANN analysis. Based on multivariate and artificial neural network analysis and our experience, we observed a trend of growing risk of BPF in the first 4 weeks (early fistula), considering the four classes. Preoperative differentiation of the patients into four risk classes could allow a correct stratification of the growing risk of developing early BPF. This information could be significant to share with patients and the other physicians during the decision-making process, to minimise the risk of BPF.
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Affiliation(s)
- Antonio Mazzella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Elena Prisciandaro
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Mauro Loi
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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10
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Bertolaccini L, Prisciandaro E, Guarize J, Spaggiari L. A proposal for a postoperative protocol for the early diagnosis of bronchopleural fistula after lung resection surgery. J Thorac Dis 2022; 13:6495-6498. [PMID: 34992827 PMCID: PMC8662483 DOI: 10.21037/jtd-21-1095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/25/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elena Prisciandaro
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Juliana Guarize
- Interventional Pneumology Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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11
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ERDOĞU V, AKER C, PEKÇOLAKLAR A, ERDUHAN S, AKSOY Y, İŞGÖRÜCÜ Ö, METİN M. Omentoplasty in the treatment of bronchopleural fistula after pulmonary resections. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.976447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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12
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Prisciandaro E, Decaluwé H, De Leyn P, Coosemans W, Nafteux P, Van Veer H, Depypere L, Lerut T, Van Raemdonck D, Ceulemans LJ. Preserving the eponym: Klinkenbergh technique for bronchial stump suturing. Acta Chir Belg 2021; 121:449-454. [PMID: 34474643 DOI: 10.1080/00015458.2021.1975390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The technique for bronchial stump suturing following lung resection which is currently applied in the Department of Thoracic Surgery at the University Hospitals Leuven, Belgium owes its name to the Dutch surgeon Dr. Klinkenbergh (1891-1985). A true pioneer of cardiothoracic surgery in Europe, Dr. Klinkenbergh dedicated himself to the surgical treatment of pulmonary tuberculosis. His work was praised by his peers for his precision and the reasoning behind every gesture. The Klinkenbergh technique consists in performing two running sutures which cross each other 'in the same manner as the laces of a shoe' to close the bronchus, limiting the occurrence of broncho-pleural fistulas. In our experience with more than 100 patients in the last 5 years (2016-2020) who underwent open pneumonectomy for benign or malignant disease, less than 2% developed post-operative broncho-pleural fistulas.
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Affiliation(s)
- Elena Prisciandaro
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Willy Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Toni Lerut
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Laurens J. Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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13
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Gelfand G, Barber E. Recognition and Management of Acute and Late Complications of Pneumonectomy: Clinical Cases and Treatment. Thorac Surg Clin 2021; 31:293-302. [PMID: 34304837 DOI: 10.1016/j.thorsurg.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Several important complications of pneumonectomy are discussed in a case-based format. Topics include chylothorax, cardiac herniation, postpneumonectomy syndrome, postpneumonectomy pulmonary edema, bronchopleural fistula, and empyema.
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Affiliation(s)
- Gary Gelfand
- Department of Surgery, Section of Thoracic Surgery, University of Calgary, Foothills Medical Centre, Room G33H, 1403 29th Street Northwest, Calgary, Alberta T2N 2T9, Canada.
| | - Evan Barber
- Department of Surgery, Section of Thoracic Surgery, University of Calgary, Foothills Medical Centre, Room G33H, 1403 29th Street Northwest, Calgary, Alberta T2N 2T9, Canada
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14
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Thoracoscopic completion bilobectomy for bronchial stenosis. Ann Thorac Surg 2021; 113:e247-e249. [PMID: 34237294 DOI: 10.1016/j.athoracsur.2021.05.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 11/21/2022]
Abstract
A 66-year-old man with primary lung cancer underwent 4-port thoracoscopic right lower lobectomy. One month postoperatively, he was diagnosed with obstructive pneumonia and bronchial stenosis of the middle lobe. Due to recurrent obstructive pneumonia, the covered self-expanding stent was placed in the middle lobar bronchus. One month later, the stent was obstructed. Six months after the initial surgery, thoracoscopic completion bilobectomy was performed; the postoperative course was uneventful. Seven years after the initial surgery, he had no recurrence. This lobectomy approach is an option for bronchial stenosis.
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15
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Yamamoto M, Anayama T, Okada H, Miyazaki R, Orihashi K. Surgical ligation level of the bronchial artery influences tissue oxygen saturation of the bronchus and the incidence of postoperative bronchofistula after pulmonary lobectomy. Quant Imaging Med Surg 2021; 11:3157-3164. [PMID: 34249642 DOI: 10.21037/qims-20-1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/07/2021] [Indexed: 11/06/2022]
Abstract
Background Lobectomy, or the removal of a lobe of the lung, is the most commonly performed lung cancer surgery. One of the most severe postoperative complications is a bronchial stump fistula, which often occurs following a right lower lobectomy. During lymph node dissection, the bronchial arteries, which supply blood to the bronchus, are cut. Subsequently, reduced blood supply to the bronchus may result in bronchofistula. We investigated the relationship between the level of the surgical ligation of the bronchial arteries and the decrease in blood flow at the bronchial stump during a right lower lobectomy. This study aimed to clarify the relationship between the anatomical amputation level of the bronchial artery and the decrease in tissue oxygen saturation at the bronchial stump, allowing us to identify a surgical procedure that reduces the risk of a bronchopleural fistula following pulmonary lobectomy and an appropriate bronchial artery amputation site that could be used in future lobectomies. Methods We developed a new system (micro-tissue oxygen saturation) that enabled the semi-quantification of the oxygen saturation of thin tissues in pinpoint during video-assisted thoracic surgery. Changes in the blood flow at the bronchial stump were examined during lymph node dissection and bronchial artery amputation using a biological pig lobectomy model. Results The regional oxygen saturation level at the bronchial wall was 95.5%±1.0% in normal conditions. A gradual decrease in regional oxygen saturation was observed, as the cutting point of the bronchial artery was moved higher. When the bronchial artery coursing into the middle lobe bronchus was preserved, the blood flow in the bronchus was preserved at 82.8%±1.3%. When the branches of the bronchial arteries running both inside and outside of the intermediate bronchial trunk were cut at high positions, regional oxygen saturation level decreased to 55.7%±1.2%. Conclusions The preservation of at least one bronchial artery at the level of the middle lobe bronchus minimizes the reduction of tissue oxygen saturation at the lower lobe bronchial stump. The ligation of bronchial arteries at a higher position results in desaturation <60%, which may increase the risk of bronchial stump fistula.
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Affiliation(s)
- Marino Yamamoto
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takashi Anayama
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hironobu Okada
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Ryohei Miyazaki
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kazumasa Orihashi
- Department of Surgery II, Kochi Medical School, Kochi University, Kochi, Japan
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16
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Asaad M, Van Handel A, Akhavan AA, Huang TCT, Rajesh A, Shen KR, Allen MA, Sharaf B, Moran SL. Prophylactic Bronchial Stump Support With Intrathoracic Muscle Flap Transposition. Ann Plast Surg 2021; 86:317-322. [PMID: 33555686 DOI: 10.1097/sap.0000000000002451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bronchopleural fistula (BPF) is a dreaded complication of pulmonary resection. For high-risk patients, bronchial stump coverage with vascularized tissue has been recommended. The goal of this study was to report our experience with intrathoracic muscle transposition for bronchial stump coverage. METHODS A retrospective review of all patients who underwent intrathoracic muscle flap transposition as a prophylactic measure at our institution between 1990 and 2010 was conducted. Demographics, surgical characteristics, and complication rates were abstracted and analyzed. RESULTS A total of 160 patients were identified. The most common lung resections performed were pneumonectomy (n = 69, 43%) and lobectomy (n = 60, 38%). A total of 168 flaps were used where serratus anterior was the most common flap (n = 136, 81%), followed by intercostal (n = 14, 8%), and latissimus dorsi (n = 12, 7%). Ten patients (6%) developed BPF, and empyema occurred in 13 patients (8%). Median survival was 20 months, and operative mortality occurred in 7 patients (4%). CONCLUSIONS Reinforcement of the bronchial closure with vascularized muscle is a viable option for potentially decreasing the incidence of BPF in high-risk patients. Further randomized studies are needed to determine the efficacy of this technique for BPF prevention.
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Affiliation(s)
- Malke Asaad
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
| | | | | | - Tony C T Huang
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
| | | | - K Robert Shen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mark A Allen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Basel Sharaf
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
| | - Steven L Moran
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
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17
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Schlachtenberger G, Doerr F, Brezina A, Menghesha H, Heldwein MB, Bennink G, Menger MD, Moussavian M, Hekmat K, Wahlers T. Perigraft reaction and incorporation of porcine and bovine pericardial patches. Interact Cardiovasc Thorac Surg 2020; 32:638-647. [PMID: 33313856 DOI: 10.1093/icvts/ivaa308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/21/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Bovine and porcine pericardial patches are frequently used in cardiothoracic and vascular surgery. There are no guidelines recommending the usage of these patches for particular surgical approaches. However, these 2 materials supposedly possess different properties. The clinical advantage of porcine compared with bovine patches remains controversial. In this experimental study, we analysed the incorporation and vascularization of bovine and porcine pericardial patches during the initial phase after implantation. METHODS Bovine and porcine pericardial patches were implanted into the dorsal skinfold chamber of C57BL/6 mice (n = 8 per group) to study vascularization and inflammation at the implantation site using repetitive intravital fluorescence microscopy over a 14-day period. At the end of the in vivo experiments, CD-31-positive cells were determined to evaluate the vascularization by immunohistochemistry. Furthermore, cell proliferation and apoptosis were analysed immunohistochemically. RESULTS Implanted bovine patches exhibited an enhanced vascularization, as indicated by a significantly higher number of CD-31-positive cells and micro-vessels (23.2 ± 4.3 vs 16.5 ± 5.8 mm-2; P = 0.001). Furthermore, bovine patches showed a slightly but not significantly higher functional capillary density. Both patches induced a moderate leukocytic inflammatory host tissue response, and neither bovine nor porcine patches significantly affected apoptosis and cell proliferation at the implantation site. CONCLUSIONS Bovine and porcine pericardial patches are similarly suitable for surgery. Bovine patches exhibited an improved vascularization during the first 14 days after implantation. This may result in a quicker and improved incorporation into the surrounding tissue compared with porcine pericardial patches.
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Affiliation(s)
| | - Fabian Doerr
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Annamaria Brezina
- Department of Anesthesiology and Intensive Care Medicine, Kerpenerstr 62, 50937 Cologne, Germany.,Institute for Clinical and Experimental Surgery, Saarland University Kirberger Strasse, 66421 Homburg/Saar, Germany
| | - Hruy Menghesha
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Matthias B Heldwein
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Gerardus Bennink
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, Saarland University Kirberger Strasse, 66421 Homburg/Saar, Germany
| | - Mohammed Moussavian
- Department of Surgery, Centre Hospitalier Emile Mayrisch (CHEM), Esch-sur-Alzette, Luxembourg
| | - Khosro Hekmat
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
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18
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Caushi F, Qirjako G, Skenduli I, Xhemalaj D, Hafizi H, Bala S, Hatibi A, Mezini A. Is the flap reinforcement of the bronchial stump really necessary to prevent bronchial fistula? J Cardiothorac Surg 2020; 15:248. [PMID: 32917252 PMCID: PMC7488725 DOI: 10.1186/s13019-020-01290-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022] Open
Abstract
Background/aim The development of bronchopleural fistula (BPF) remains the most severe complication of lung resection, especially after pneumonectomy. Studies provide controversial reports regarding the benefits of flap reinforcement of the bronchial stump (FRBS) in preventing BPF’s occurrence. Methods This is a retrospective cohort study of 558 patients that underwent lung resection in a 12-year period (from 2007 to 2018). Ninety patients (16.1%) underwent pneumonectomy. Patient follow-up period varied from 1 to 12 years. Results Out of 558 patients in this study, 468 (83.9%) underwent lobectomy, and the remnant underwent pneumonectomy. In 114 cases with lobectomy, only 24.4% had FRBS, meanwhile in 56 cases with pneumonectomy only 62.2% had FRBS. BPF occurred in 8 patients with lobectomy (1.7%) and in 10 patients with pneumonectomy (11.1%). Among cases with post-pneumonectomy BPF, 6 (10.7%) had FRBS performed, while no FRBS was performed among patients with post-lobectomy BPF, although these data weren’t statistically (p > 0.05). In 24 patients (20 lobectomies and 4 pneumonectomies) with lung cancer (10.4%) neoadjuvant treatment was performed, in which 20 patients underwent chemotherapy and 4 underwent radiotherapy. FRBS was applied in each of the above 24 operative cases, but only in 4 of them the BPF was verified. Conclusion The idea of enhancing the blood supply through the FRBS for BPF prevention has gain traction. Although FRBS has been identified as valuable and effective method in BPF prevention following lung resection, our study results did not support this evidence.
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Affiliation(s)
- Fatmir Caushi
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania. .,Department of Surgery, Our Lady of Good Counsel University, Tirana, Albania.
| | - Gentiana Qirjako
- Department of Public Health, University of Medicine, Tirana, Albania
| | - Ilir Skenduli
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Daniela Xhemalaj
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Hasan Hafizi
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Silva Bala
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Alban Hatibi
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Arian Mezini
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
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19
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Clark JM, Cooke DT, Brown LM. Management of Complications After Lung Resection: Prolonged Air Leak and Bronchopleural Fistula. Thorac Surg Clin 2020; 30:347-358. [PMID: 32593367 PMCID: PMC10846534 DOI: 10.1016/j.thorsurg.2020.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Prolonged air leak or alveolar-pleural fistula is common after lung resection and can usually be managed with continued pleural drainage until resolution. Further management options include blood patch administration, chemical pleurodesis, and 1-way endobronchial valve placement. Bronchopleural fistula is rare but is associated with high mortality, often caused by development of concomitant empyema. Bronchopleural fistula should be confirmed with bronchoscopy, which may allow bronchoscopic intervention; however, transthoracic stump revision or window thoracostomy may be required.
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Affiliation(s)
- James M Clark
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, 2335 Stockton Boulevard, 6th Floor North Addition Office Building, Sacramento, CA 95817, USA. https://twitter.com/JamesClarkMD
| | - David T Cooke
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, 2335 Stockton Boulevard, 6th Floor North Addition Office Building, Sacramento, CA 95817, USA. https://twitter.com/DavidCookeMD
| | - Lisa M Brown
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, 2335 Stockton Boulevard, 6th Floor North Addition Office Building, Sacramento, CA 95817, USA.
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20
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Wang YQ, Zhuang W. Treat bronchopleural fistula after right lower lobectomy by extra right middle lobectomy-a neglected approach. Interact Cardiovasc Thorac Surg 2020; 31:63-70. [PMID: 32259254 DOI: 10.1093/icvts/ivaa050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/23/2020] [Accepted: 02/12/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Bronchopleural fistula (BPF) after right lower lobectomy (RLL), although uncommon, is associated with high mortality rates. This study was aimed at evaluating the therapeutic effect of extra right middle lobectomy (ERML) in the management of BPF after RLL. METHODS We investigated 12 consecutive patients who were treated at our hospital for BPF occurring after RLL. The diagnosis of BPF was established by bronchoscopy in all cases and BPFs were treated by ERML. All patients were followed up for at least 1 year after ERML to assess treatment outcomes. RESULTS The severity of infection and malnutrition after BPF was different for different patients. All patients agreed to undergo ERML. The procedure was uneventful in all cases, and there were no cases of perioperative complications or death. The median duration of hospitalization after ERML was 10.5 (range 6-21) days. Postoperative pathological examination showed the presence of hyperaemia and oedema in the BPF stump, and inflammatory cell infiltration in the stroma. The fresh stump of the bronchus intermedius was well structured. Patients were followed up for a median duration of 27 (range 12-41) months. The BPFs were successfully treated in all patients, and a new BPF did not develop in the new fresh stump in any of the cases. CONCLUSIONS ERML aimed at creating a fresh stump for quick healing could be alternative for treating BPF after RLL.
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Affiliation(s)
- Yan-Qing Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhuang
- Department of Thoracic Surgery, Xiangya Hospital of Central South University, Hunan, China
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21
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Matthews CR, Goswami D, Ramchandani NK, Huffard AL, Rieger KM, Young JV, Martinez RV, Kesler KA. The Influence of Airway Closure Technique for Right Pneumonectomy on Wall Tension During Positive Pressure Ventilation: An Experimental Study. Semin Thorac Cardiovasc Surg 2020; 32:1076-1084. [PMID: 32442665 DOI: 10.1053/j.semtcvs.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/01/2020] [Indexed: 11/11/2022]
Abstract
Bronchopleural fistula (BPF) remains a significant source of morbidity and mortality after right pneumonectomy (RPN). Postoperative mechanical ventilation represents a primary risk factor for BPF. We undertook an experiment to determine the influence of airway diameter on suture line tension during mechanical ventilation after RPN. RPN was performed in 6 fresh human adult cadavers. After initial standard bronchial stump closure (BSC), the airway suture lines were subjected to 5 cm H2O incremental increases in airway pressures beginning at 5-40 cm H2O. To minimize airway diameter, a carinal resection was then performed with trachea to left main bronchial anastomosis and the airway suture lines subjected to similar incremental airway pressures. Wall tension (N/m) at the suture lines was measured using piezoresistive sensors at each pressure point. As delivered airway pressure increased, there was a concomitant increase in wall tension after BSC and carinal resection. At every point of incremental positive pressure, wall tension was however significantly lower after carinal resection when compared to BSC (P < 0.05). Additionally the differences in airway tension became even more significant with higher delivered airway pressure (P < 0.001). Airway diverticulum after BSC leads to significantly increased tension on the bronchial closure with positive airway pressure as compared to a closure which minimize airway diameter after RPN. This supports the role of Laplacian Law where small increases in airway diameter result in significant increases on closure site tension. Techniques which reduce airway diameter at the airway closure will more reliably reduce the incidence of BPF following RPN.
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Affiliation(s)
- Caleb R Matthews
- Indiana University Melvin and Bren Simon Cancer Center, Department of Surgery, Division of Cardiothoracic Surgery, Indianapolis, Indiana
| | - Debkalpa Goswami
- Purdue University, School of Industrial Engineering, West Lafayette, Indiana
| | - Neal K Ramchandani
- Indiana University Melvin and Bren Simon Cancer Center, Department of Surgery, Division of Cardiothoracic Surgery, Indianapolis, Indiana
| | - Adrian L Huffard
- Indiana University Melvin and Bren Simon Cancer Center, Department of Surgery, Division of Cardiothoracic Surgery, Indianapolis, Indiana
| | - Karen M Rieger
- Indiana University Melvin and Bren Simon Cancer Center, Department of Surgery, Division of Cardiothoracic Surgery, Indianapolis, Indiana
| | - Jerry V Young
- Indiana University Melvin and Bren Simon Cancer Center, Department of Anesthesiology, Indianapolis, Indiana
| | - Ramses V Martinez
- Purdue University, School of Industrial Engineering, West Lafayette, Indiana; Purdue University, Weldon School of Biomedical Engineering, West Lafayette, Indiana
| | - Kenneth A Kesler
- Indiana University Melvin and Bren Simon Cancer Center, Department of Surgery, Division of Cardiothoracic Surgery, Indianapolis, Indiana.
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22
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PREOPERATIVE ENDOBRONCHIAL SANITATION AS PREPARATION FOR THORACIC INTERVENTIONS. EUREKA: HEALTH SCIENCES 2020. [DOI: 10.21303/2504-5679.2020.001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim – to study the effectiveness of endoscopic photodynamic therapy as a preoperative preparation of the tracheobronchial tree in patients with lung cancer.
Materials and methods. The study included 181 patients with II-III stage of lung’s cancer. Diagnose of lung’s cancer was confirmed with a morphologically and concomitant endobronchitis. During the preoperative preparation, we used a technique developed by us introducing into the tracheobronchial tree an aqueous solution of brilliant green at concentration of 0.04 %, followed by irradiation of this solution with laser radiation with the wavelength of 0.63 μm (AFL-2 helium-neon laser) in an independent form and in combination with traditional anti-inflammatory therapy. Endoscopic endobronchial sanitation therapy was carried out by low-intensity radiation of the red part of the spectrum (λ=0.63–0.66 μm) in a pulsed mode, with a power of 12 mW.
Results. After 3–5 days of the start preoperative preparation and 1–2 sessions of endoscopic bronchosanation, the general state of patients was improved, the amount of sputum decreased and was changing from mucopurulent to mucous. To completely stop the clinical phenomena of endobronchitis, it was necessary to conduct 5-6 sessions of endoscopic photodynamic therapy according to our methodology, with the introduction of our method. In patients without pronounced clinical symptoms of concomitant chronic bronchitis, it was enough to complete only 3 sessions of bronchosanation.
Conclusion. Endoscopic photodynamic bronchosanation in the preoperative period in patients for correcting accompanying endobronchitis can significantly reduce or completely stop the clinical manifestations of endobronchitis in the shortest time and leads to a significant decrease in the number of endobronchial complications in surgical and combined treatment of lung cancer.
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23
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Nagashima T, Ito H, Samejima J, Nemoto D, Eriguchi D, Nakayama H, Woo T, Masuda M. Postoperative changes of the free pericardial fat pad for bronchial stump coverage. J Thorac Dis 2020; 11:5228-5236. [PMID: 32030240 DOI: 10.21037/jtd.2019.11.81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Bronchopleural fistula (BPF) remains a serious complication after surgery for lung cancer with bronchial resection. A free pericardial fat pad (FPFP) is applied in high-risk cases to reduce BPF frequency. BPF may occur 6 months after surgery. Thus, we evaluated the residual FPFP volume at 6 months after surgery to estimate the residual FPFP ratio and determine the amount of FPFP to be harvested during surgery. Methods We retrospectively investigated 40 patients who underwent lobectomy with bronchial stump coverage using FPFP. During surgery, the volume of the harvested FPFP was measured and the FPFP was affixed to the bronchial stump. Further, 6 months after surgery, the residual volume of the installed FPFP was analyzed using a three-dimensional volume analyzer and the residual ratio was calculated. We also evaluated clinicopathological factors influencing the resected FPFP and residual ratio. Results The median resected FPFP volume was 11 [3-40] mL. During multivariate analysis, body mass index and surgical approach were found to be significant factors associated with the resected FPFP volume. The median residual FPFP volume was 4.3 (0.4-15.5) mL. The median residual ratio was 0.39 (0.13-0.66). The resected FPFP volume was significantly associated with the residual volume (P<0.001) but not with the residual ratio (P=0.811). No factor was associated with the residual ratio. Conclusions In all cases, residual FPFP was confirmed at 6 months after surgery and the residual ratio was 40%. It is necessary to determine the volume of FPFP to be harvested while carefully considering the shrinkage ratio.
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Affiliation(s)
- Takuya Nagashima
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Joji Samejima
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Daiji Nemoto
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Daisuke Eriguchi
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Tetsukan Woo
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
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24
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Faccioli E, Bellini A, Mammana M, Monaci N, Schiavon M, Rea F. Extrapleural pneumonectomies for pleural mesothelioma. Expert Rev Respir Med 2019; 14:67-79. [PMID: 31674841 DOI: 10.1080/17476348.2020.1688147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Malignant pleural mesothelioma (MPM) is a fatal malignancy for which there is no definitive cure. The most effective multimodality treatment in prolonging survival is still matter of debate. Surgery remains one of the cornerstones in the multimodality therapy for MPM. Extra-pleural pneumonectomy and pleurectomy/decortication are the two main curative-intent procedures; however, the superiority of one technique over the other is still debated. This review aims to assess short- and long-term results of extrapleural pneumonectomy for MPM.Areas covered: This article focuses on the role of extrapleural pneumonectomy in MPM. A systematic review was performed by using electronic databases to identify studies that included patients treated by this procedure for MPM. Endpoints included overall survival, disease-free survival, recurrence rate, perioperative mortality, and morbidity.Expert commentary: This paper offers an overview of the results that are currently obtained in patients undergoing extrapleural pneumonectomy for MPM. The benefit of surgical treatments in MPM is still debated and its primary goal should be the achievement of a macroscopic complete resection. Several alternative multimodality protocols exist, with specific advantages and drawbacks; therefore, individualization of care for each patient is fundamental. The complexity of the surgical treatment mandates that patients be referred to specialized centers.
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Affiliation(s)
- Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Alice Bellini
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Nicola Monaci
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
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25
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Mammana M, Marulli G, Zuin A, Perissinotto E, Comacchio GM, De Franceschi E, Rea F. Postpneumonectomy bronchopleural fistula: analysis of risk factors and the role of bronchial stump coverage. Surg Today 2019; 50:114-122. [PMID: 31493198 DOI: 10.1007/s00595-019-01871-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Bronchopleural fistula (BPF) is a potentially fatal complication of pneumonectomy. We analyze its occurrence rate, risk factors, and the methods used for its prevention. METHODS We reviewed the medical records of patients who underwent pneumonectomy at our Institution between January, 1990 and March, 2016. The risk factors for postoperative BPF were analyzed by univariate analysis and multiple logistic regression. RESULTS Over the study period, 511 patients underwent pneumonectomy for non-small cell lung cancer (NSCLC) and had the bronchus closed by manual suturing. BPF developed in 23 patients (4.5%). Multiple logistic regression identified no coverage of the bronchial stump, right-sided pneumonectomy, residual tumor in the bronchial stump, postoperative ventilatory support, and completion pneumonectomy, as independent risk factors for BPF. The cumulative rate of BPF decreased significantly over time from 18% between 1990 and 1995 to 1% between 2011 and 2016 (p < 0.001). Concurrently, the data of several patients showed a significant positive trend over time, including bronchial stump coverage (BSC). DISCUSSION Several known risk factors for BPF were confirmed. The more frequent usage of tissue flaps for coverage of the bronchial stump may have contributed to the reduction in the rate of postoperative BPF over time.
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Affiliation(s)
- Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation, University Hospital of Bari, Piazza Giulio Cesare, 11, 70120, Bari, Italy.
| | - Andrea Zuin
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Egle Perissinotto
- Biostatistic Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giovanni Maria Comacchio
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Elisa De Franceschi
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
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Kuroda H, Sugita Y, Nakanishi K, Oya Y, Sakakura N, Sakao Y. Favorable clinical application for segmental bronchial closure based on experiment results. J Thorac Dis 2019; 11:2267-2273. [PMID: 31372263 DOI: 10.21037/jtd.2019.06.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We previously reported the clinical application of powered vascular staple (PVS) for closure of subsegmental or segmental bronchus (SSB). This study aimed to measure breakdown pressure in experiment and to investigate bronchopleural fistula (BPF) after thoracoscopic segmentectomy (TS). Methods Part 1: a total of 30 cadaveric pigs were used, and bronchi were categorized into the following four groups: small [S, bronchial outer diameter (BOD) of 4-8 mm, n=8], medium (M, 9-10 mm, n=9), and large (L, >10 mm, n=13). We additionally added a single additional suture to compensate for weak sites with large BOD (group R, n=6). The pressure was slowly increased, and stump breakdown was observed. Part 2: we investigated the morbidity of BPF formation at follow-up of at least 6 months in a total of 217 patients. Results Part 1: the mean leak pressure was the highest in M, followed by groups S, R and L'. However, the significant difference was not found between S and R. Part 2: no BPF was observed, clinically. Conclusions Based on experimental results and clinical experience, the proper selection of PVS should contribute to the safety, feasibility, and success as SSB closure.
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Affiliation(s)
- Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
| | - Yusuke Sugita
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
| | - Keita Nakanishi
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
| | - Yuko Oya
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan.,Departmet of Thoracic Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
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Cusumano G, Alifano M, Lococo F. Endoscopic and surgical treatment for bronchopleural fistula after major lung resection: an enduring challenge. J Thorac Dis 2019; 11:S1351-S1356. [PMID: 31245131 DOI: 10.21037/jtd.2019.03.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giacomo Cusumano
- Unit of Thoracic Surgery, "Policlinico Vittorio Emanuele Hospital", Catania, Italy
| | - Marco Alifano
- Department of Thoracic surgery, Groupe Hospitalier Cochin Hôtel-Dieu, AP-HP, Université Paris Descartes, Paris
| | - Filippo Lococo
- Unit of Thoracic Surgery, Azienda Unica Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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28
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[Postoperative complications after major lung resection]. Rev Mal Respir 2019; 36:720-737. [PMID: 31208887 DOI: 10.1016/j.rmr.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 09/08/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The advent of the minimally invasive techniques has allowed an expansion of the indications for thoracic surgery, particularly in older patients and those with more comorbidities. However, the rate of postoperative complications has remained stable. STATE OF THE ART Postoperative complications are defined as any variation from the normal course. They occur in 30% but majority of them are minor. The 30-day mortality rate for lung resection varies range between 2 % and 3% in the literature. Complications can be classified as: (1) early (occurring in the first 24hours) including both "generic" surgical complications (especially postoperative bleeding) and complications more specific to lung surgery (Acute respiratory syndrome, atelectasis); (2) in-hospital complications and those occurring during the first 3 months; these are dominated by infectious events in particular pneumonia but also bronchial (bronchopleural fistula), pleural (pneumothorax, hydrothorax) or cardiac complications; (3) late complications are dominated by chronic pain, affecting 60% of patients having a thoracotomy at three months. Lobectomy is the most common lung resection. Pneumonectomy is a distinct procedure requiring a specific peri- and postoperative management. Right pneumonectomy is associated with a higher risk with a treatment related-mortality ranging between 7 and 10%. CONCLUSION Major lung resection has benefited from minimally invasive approaches and fast track to surgery. However, it is important to note the occurrence of new and specific complications related to those news surgical access.
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Botianu PVH. Current indications for the intrathoracic transposition of the omentum. J Cardiothorac Surg 2019; 14:103. [PMID: 31182112 PMCID: PMC6558767 DOI: 10.1186/s13019-019-0924-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 05/28/2019] [Indexed: 12/30/2022] Open
Abstract
Background The intrathoracic transposition of the omentum (ITO) has been reported with more or less good results in various clinical circumstances but with no clear guidelines or indications. Methodology and review This article reviews the main clinical situations in which omento-plasty (OP) may be taken into consideration by the thoracic surgeons: mediastinitis and deep sternal infections after median sternotomy, reinforcement of the eso-gastric anastomosis after esophagectomy, prevention and treatment of the bronchial fistula after pulmonary resection, space-filling procedures for empyema, mediastinal tracheostomy, management of the infected intrathoracic vascular grafts / ventricular assist devices and heart OP. For each clinical situation we have performed a literature review with analysis of the most relevant published papers searching for an evidence-based approach for the use of the ITO/OP in thoracic surgery. Conclusions OP may be an elegant solution for a wide range of problems in thoracic surgery. In the published literature, there are mainly case-reports and relatively small series published resulting in a low level of evidence for both ITO as a surgical technique by itself, as well as for the use of OP in various clinical situations involving the chest structures. The indications for its use in thoracic surgery are based more on common sense and the lack of other solutions.
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Affiliation(s)
- Petre V H Botianu
- Surgery IV Discipline, M5 Department, University of Medicine and Pharmacy from Tirgu-Mures, 540091 Bujorului 2A, Tirgu-Mures, Romania.
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Duan H, Tong L, Zhu Y, Dong X, Zhang Y, Liu H, Yan X. Secondary resection tracheal was facilitated in robot-assisted left pneumonectomy. J Thorac Dis 2018; 10:7005-7008. [PMID: 30746246 PMCID: PMC6344697 DOI: 10.21037/jtd.2018.11.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/23/2018] [Indexed: 11/06/2022]
Abstract
The purpose of the essay is to introduce a new procedure in term of robot-assisted left pneumonectomy. The "secondary resection tracheal" technique is that, the left bronchi, which was 3-4 cm apart from trachea carina was disserted firstly, as the distal bronchi stump was lifted, with more space and vision being explored, the artery was pinned down easily, chipped and cut accurately. As far as the program goes down, it is more privileged but one point where it was capable of avoiding or decreasing the risk of ripping the left artery. In addition to isolating, lifting or tracting the proximal tracheal stump, the endo-GIA staple was much easier used to cut the tracheal stump secondly and to deliver shorter one as well as to reduce the odds of the bronchial stump fistula. Moreover, for the preliminary date has indicated, there's been a significant decrease in intraoperative hemorrhage involving with the left pneumonectomy.
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Affiliation(s)
- Hongtao Duan
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Liping Tong
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Yifang Zhu
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Xiaoping Dong
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Yong Zhang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Honggang Liu
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Xiaolong Yan
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
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Bribriesco A, Patterson GA. Management of Postpneumonectomy Bronchopleural Fistula: From Thoracoplasty to Transsternal Closure. Thorac Surg Clin 2018; 28:323-335. [PMID: 30054070 DOI: 10.1016/j.thorsurg.2018.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Development of postpneumonectomy empyema with bronchopleural fistula is a life-threatening condition that requires prompt action. Although measures should be taken to prevent bronchopleural fistula at time of pneumonectomy, many patients experience this complication. Management focuses on drainage of the pleural space, control of the pleural infection including repair of the bronchopleural fistula, and obliteration of the residual pleural cavity. Multiple techniques and procedures have been developed over time to achieve these goals. Knowledge of the diverse therapeutic options is important to select the optimal treatment for these complex patients.
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Affiliation(s)
- Alejandro Bribriesco
- Department of Thoracic & Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J4-1, Cleveland, OH 44195, USA.
| | - G Alexander Patterson
- Division of Cardiothoracic Surgery, Washington University in St. Louis, 660 South Euclid, Campus Box 8234, St Louis, MO 63110, USA
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Risk assessments for broncho-pleural fistula and respiratory failure after lung cancer surgery by National Clinical Database Japan. Gen Thorac Cardiovasc Surg 2018; 67:297-305. [DOI: 10.1007/s11748-018-1022-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
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Ariyaratnam P. Is It Time for a Perioperative Registry on Pneumonectomy Surgery? Ann Thorac Surg 2018; 107:986. [PMID: 30315801 DOI: 10.1016/j.athoracsur.2018.08.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 11/17/2022]
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34
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Chu X. [Bronchopleural Fistula - the Pulmonary Surgery Complications that Should Be Emphasized by Thoracic Surgeons]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:239-240. [PMID: 29587952 PMCID: PMC5973032 DOI: 10.3779/j.issn.1009-3419.2018.03.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Xiangyang Chu
- Department of Thoracic Surgery, PLA General Hospital
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35
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Okuda M, Go T, Yokomise H. Risk factor of bronchopleural fistula after general thoracic surgery: review article. Gen Thorac Cardiovasc Surg 2017; 65:679-685. [DOI: 10.1007/s11748-017-0846-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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Li SJ, Zhou XD, Huang J, Liu J, Tian L, Che GW. A systematic review and meta-analysis-does chronic obstructive pulmonary disease predispose to bronchopleural fistula formation in patients undergoing lung cancer surgery? J Thorac Dis 2016; 8:1625-38. [PMID: 27499951 DOI: 10.21037/jtd.2016.05.78] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND we conducted this systematic meta-analysis to determine the association between chronic obstructive pulmonary disease (COPD) and risk of bronchopleural fistula (BPF) in patients undergoing lung cancer surgery. METHODS Literature retrieval was performed in PubMed, Embase and the Web of Science to identify the full-text articles that met our eligibility criteria. Odds ratio (OR) with 95% confidence interval (CI) served as the summarized statistics. Q-test and I(2)-statistic were used to evaluate the level of heterogeneity. Sensitivity analysis was performed to further examine the stability of pooled OR. Publication bias was detected by both Begg's test and Egger's test. RESULTS Eight retrospective observational studies were included into this meta-analysis. The overall summarized OR was 2.03 (95% CI: 1.44-2.86; P<0.001), revealing that COPD was significantly associated with the risk of BPF after lung cancer surgery. In subgroup analysis, the relationship between COPD and BPF occurrence remained statistically prominent in the subgroups stratified by statistical analysis (univariate analysis, OR: 1.91; 95% CI: 1.35-2.69; P<0.001; multivariate analysis, OR: 3.18; 95% CI: 1.95-5.19; P<0.001), operative modes (pneumonectomy, OR: 2.11; 95% CI: 1.15-3.87; P=0.016) and in non-Asian populations (OR: 2.36; 95% CI: 1.18-4.73; P=0.016). No significant impact of COPD on BPF risk was observed in Asian patients (OR: 1.48; 95% CI: 0.85-2.57; P=0.16). No significant heterogeneity or publication bias was discovered across the included studies. CONCLUSIONS Our meta-analysis indicates that COPD can significantly predispose to BPF formation in patients undergoing lung cancer surgery. Because some limitations still exist in this meta-analysis, our findings should be further verified and modified in the future.
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Affiliation(s)
- Shuang-Jiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Xu-Dong Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Jian Huang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Jing Liu
- Institution of Medical Statistics, West China School of Public Health, Sichuan University, Chengdu 610065, China
| | - Long Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Guo-Wei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
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Li SJ, Fan J, Zhou J, Ren YT, Shen C, Che GW. Diabetes Mellitus and Risk of Bronchopleural Fistula After Pulmonary Resections: A Meta-Analysis. Ann Thorac Surg 2016; 102:328-39. [DOI: 10.1016/j.athoracsur.2016.01.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/30/2015] [Accepted: 01/04/2016] [Indexed: 01/14/2023]
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38
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Matsuoka K, Imanishi N, Yamada T, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. Clinical results of bronchial stump coverage using free pericardial fat pad. Interact Cardiovasc Thorac Surg 2016; 23:553-9. [DOI: 10.1093/icvts/ivw193] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 05/10/2016] [Indexed: 11/13/2022] Open
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39
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Li S, Fan J, Liu J, Zhou J, Ren Y, Shen C, Che G. Neoadjuvant therapy and risk of bronchopleural fistula after lung cancer surgery: a systematic meta-analysis of 14 912 patients. Jpn J Clin Oncol 2016; 46:534-46. [DOI: 10.1093/jjco/hyw037] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/26/2016] [Indexed: 01/11/2023] Open
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Kocher GJ, Hoksch B, Lutz J, Schmid RA. Single-incision thoracoscopic right pneumonectomy with primary division of the pulmonary artery. J Vis Surg 2016; 2:41. [PMID: 29078469 DOI: 10.21037/jovs.2016.02.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 11/06/2022]
Abstract
In recent years video-assisted thoracoscopic surgery (VATS) techniques have gained popularity also for major lung resections. Furthermore, especially in experienced VATS centers, single-incision thoracoscopic surgery is more and more adapted due to its even lesser invasiveness. Most thoracic surgeons still prefer an open approach to perform pneumonectomy, although reports of VATS and even single-incision VATS pneumonectomy are increasing. Unlike other authors we prefer to divide the pulmonary artery (PA) as one of the first steps of the procedure in order to obtain a clear field of vision on one hand and to obtain optimal control of bleeding and total blood loss on the other hand. Herein we describe our technique for single incision thoracoscopic right pneumonectomy and mediastinal lymphadenectomy without rib-spreading and with division of the PA as a first step. Furthermore we prefer to routinely cover the bronchial stump (BS) with an in situ azygos vein (AV) flap during right pneumonectomy.
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Affiliation(s)
- Gregor J Kocher
- Division of General Thoracic Surgery, University Hospital Bern/Inselspital, Bern, Switzerland
| | - Beatrix Hoksch
- Division of General Thoracic Surgery, University Hospital Bern/Inselspital, Bern, Switzerland
| | - Jon Lutz
- Division of General Thoracic Surgery, University Hospital Bern/Inselspital, Bern, Switzerland
| | - Ralph A Schmid
- Division of General Thoracic Surgery, University Hospital Bern/Inselspital, Bern, Switzerland
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Li S, Fan J, Zhou J, Ren Y, Shen C, Che G. Residual disease at the bronchial stump is positively associated with the risk of bronchoplerual fistula in patients undergoing lung cancer surgery: a meta-analysis. Interact Cardiovasc Thorac Surg 2015; 22:327-35. [PMID: 26614527 DOI: 10.1093/icvts/ivv327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/24/2015] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Residual disease at the bronchial stump (RDBS) is regarded as an important factor possibly resulting in bronchopleural fistula (BPF) after lung cancer surgery, but this has not been confirmed. We conducted this meta-analysis to evaluate the effects of RDBS on BPF formation in patients undergoing lung cancer surgery. METHODS PubMed and EMBASE databases were searched for full-text articles that met our eligibility criteria. Odds ratios (ORs) with 95% confidence interval (95% CI) served as the summarized outcomes. Q-test and I(2) statistic were used to evaluate the level of heterogeneity, determining the fixed-effect model or random-effect model for quantitative synthesis. Sensitivity analysis was conducted to identify the possible origins of heterogeneity. The publication bias was assessed by Begg's test. RESULTS A total of eight retrospective observational studies were included in our meta-analysis. In overall analysis, the pooled outcomes indicated that RDBS was significantly associated with BPF formation after lung cancer surgery (OR: 3.12; 95% CI: 1.72-5.64; P < 0.001). In subgroup analysis, the pooled outcomes revealed a significantly increased risk of post-pneumonectomy BPF in patients with RDBS (OR: 2.78; 95% CI: 1.06-7.28; P = 0.037). The subgroup analysis assessing the effects of RDBS on post-lobectomy BPF was given up due to the scarcity of available data. No heterogeneity was revealed within this meta-analysis. No evidence for publication bias was detected by Begg's test. CONCLUSIONS Our meta-analysis indicates that RDBS is positively associated with the increased risk of BPF in patients undergoing lung cancer surgery. The further analysis also reveals an increased risk of post-pneumonectomy BPF in patients with RDBS. More accurate and comprehensive evidence should be collected and summarized in updated meta-analyses.
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Affiliation(s)
- Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Fan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yutao Ren
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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